INFECTION PREVENTION AND CONTROL
Controlling healthcare acquired infections
Dr Ojan Assadian – president of the Austrian Society for Infection Control and a team from Novaerus, a global company working to disinfect and purify indoor air for optimal human health, examine the current limitations of hand hygiene and surface cleaning. They believe a third strategy – air disinfection, to inactivate viable particles before they settle on surfaces, can provide additional protection against infection.
Hospitals today face an acute crisis: the spread of infection among patients. In high- income countries, 5% to 10% of hospitalised patients - including 30% of patients in intensive care units - contract an infection during their stay.1 the United States,3
Each year, in Europe2 and hospital pathogens infect
nearly 6 million patients and are responsible for 140,000 deaths. On any given day, more than 1.4 m hospitalised patients around the world4 and 80,000 in Europe5
are estimated to have at
least one healthcare associated infection; compared to other patients, they may be 80% more likely to die within 90 days.6
In
developing countries, as the World Health Organization (WHO) notes, the childhood death rate from hospital acquired infections equates to “a plane crashing every hour.”7 Even the cleanest hospitals can serve as breeding grounds for dangerous microbes. Viral particles launched by a sneeze - or by a change of bed linens - hover in the air, to be inhaled by patients or to land on intravenous
The costs to hospitals
Patients who acquire infections from surgery spend, on average, an additional 6.5 days in the hospital and are five times more likely to be readmitted after discharge10
Those infected by an antimicrobial- resistant pathogen, aka: “superbug,” may spend an additional 16.9 days in the hospital11
A single methicillin-resistant Staphylococcus aureus (MRSA) infection in the neonatal intensive care unit can extend the infant’s hospital stay by 40 days.12
Hand hygiene lapses
poles. Pathogens deposited into a box of surgical gloves hitch a ride, via central line, to a patient’s bloodstream, or via catheter to the urinary tract. Bacteria travel from the bed rail of an infected patient to the hands of a nurse, and from there to vulnerable patients.8 The web of transmission routes is vast, complex, and invisible. Pneumonia, meningitis, colitis, gastroenteritis, peritonitis, sepsis - the infections acquired at hospitals can be serious and debilitating. Many turn lethal, or nearly so, because of a parallel crisis: the dramatic increase in antimicrobial resistance.
Because of antibiotic misuse, antimicrobial treatment is increasingly difficult and less successful. “We’ve reached the point where patients are dying of infections in hospitals that we have no antibiotics to treat,” said Arjun Srinivasan, MD, associate director for healthcare associated prevention programs at the US Centers for Disease Control.9 Hospitals are confronting high readmission rates, higher mortality rates, temporary closures due to infection outbreaks, and an alarmed public. Headlines such as “Your Hospital Can Make You Sick” do not inspire confidence.
None of this will come as news to informed hospital staff. But what may surprise even those immersed in infection control: hand hygiene and surface cleaning, long considered the gold-standard solutions, will not suffice to halt this crisis, even if
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compliance rates are improved. These strategies, along with strong policies to halt antibiotic misuse, remain as critical as ever, but they also are inherently limited – and, in the superbug era, increasingly inadequate. “We are trying to solve problems of today with instruments of the past,” said Ojan Assadian, MD, an infectious disease consultant and president of the Austrian Society for Infection Control. “It is time to rethink our approach and combine existing strategies with new technology.”13 A substantial portion of hospital acquired infections are preventable - including up to 70% of bloodstream infections transmitted by catheter and 55% of ventilator-associated pneumonia and surgical site infections.14
to achieve gains, hospitals must become more diligent about preventing infection and more innovative in their approach.
Hand hygiene compliance: “The dirty hand in the latex glove”
Healthcare workers’ hands are the chief vehicle for pathogen transmission at hospitals.15
Accordingly, healthcare workers’ hands, whether bare or gloved, can become contaminated even after seemingly “clean” procedures, such as taking a pulse or a temperature or touching a patient’s groin.
Pathogens can proliferate even on intact skin – in the armpit, on the chest and back, around the perineum - and have “an impressive ability to survive on the hands, sometimes for hours,” as WHO notes.16
SEPTEMBER 2018
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